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r"s �-'��^a �,�'r `��st a""i ,e , <br /> ��F��r'� �`�'�''�;lFwh�h;�`t'T�3��ro� c '���. � �, <br /> ,;"s��'r�3,� "��'- ` �, <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to elechical or gas service. <br /> 2. Has a t o of$500.00 or less;ex 1 ' the cost of the fixture or appliance:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> ��� ��.; � � <br /> ,� �v �. �s�„�;a,,;-.. <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> 4,500.00 X.o12s$ 56.25 <br /> (cont►act price) (minimum$50.00) <br /> 2. STATE SURCHARGE 4,5��.�0 2.25 <br /> x.0005 $ <br /> (conhact price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $58.5� <br /> • * CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount charged for the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material, equipment, labor or installations are furnished by <br /> the owner, tenant or any other party, the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> .n���* �, ,�;��;��,���:;" <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all ements made on this application are complete, true and <br /> correct. <br /> � <br /> � <br /> Applicant's Signature: `� �Date: O1/19/�2 <br /> ���'��`�t� �, .*F�'� •li'4 Y.}yTy� ���� <br /> � �; <br /> � <br /> .r kxs ...s�f' , y�$aJ K�; ��. <br /> � 3 <br />